Point-of-care monitoring of feto-placental oxygen uptake Summary / Abstract The ?Great Obstetrical syndromes? are the leading cause of maternal and fetal mortality world-wide. Despite the fact, that the origin of these syndromes is associated with pathology of deep placentation and abnormal vascular remodeling, there are no tools, allowing early point-of-care diagnosis, prior to maternal pregnancy complication become evident and pathophysiological cascade of events develops. Pathology of deep placentation leads to abnormal blood flow in materno-fetal unit and to inefficient oxygen exchange between maternal and fetal circulations, which could be measured as uterine arterio-venous oxygen ratio (AVOR). The optoacoustic imaging technology would potentially allow measuring AVOR with unprecedented accuracy during the window of opportunity for early intervention. While the first clinical application of optoacoustic tomography enabled functional imaging, many burdens remain to be removed. The accuracy of quantitative information, contrast and resolution and image artifacts and video rate of blood content and its oxygen saturation are still not sufficient for usage at the patient's bedside. However recent breakthroughs in the system components give solid basis for development of a compact, robust and inexpensive functional imaging technology. Thus, based on pathophysiological relevance of uterine arterio-venous oxygen ratio (AVOR) in pregnancy complication and the progress in the optoacoustic biophysical methods, we propose to develop the first clinical prototype system of a novel hybrid laser optoacoustic-ultrasonic medical device (MD) for noninvasive evaluation of spatially resolved maps of blood flow and its oxygen content in uterine venous and arterial vascular trees (AVOR-MD). Thus Aim 1 of the proposed study is to develop a compact, robust and accurate functional system for monitoring differences in veno-arterial blood oxygenation; Aim 2 is to perform feasibility testing of the developed system and method initially in phantoms and then in ex-vivo studies of blood perfused placenta. In the Phase I of the SBIR project we will develop the system specifications, fabricate the dual modality optoacoustic-ultrasonic probe, improve speed and quantitative accuracy of functional imaging and demonstrate feasibility of our approach in ex vivo blood-perfused organs, including human placenta. The team of investigators has a unique, 60 years combined experience in obstetrics and gynecology, placental biology and biophysics. The successful completion of this proposal will allow simple, rapid diagnosis of life threatening pregnancy complications prior to the development of clinical syndromes, moreover ? the proposed equipment could be used in neonatal care. 1